Acting out Behavior Management 2

Whether we work in health care, education, or any human services field, we might have to deal with angry, hostile, or noncompliant behavior on any day. Our appropriate response to defensive behavior is often the key to avoiding a physical confrontation with someone who has lost control of their behavior.

I. Definition: Acting out behavior refers to problem behavior that is physically aggressive, destructive to property, verbally aggressive, or otherwise more severe than simple misbehavior. Acting out behavior is disruptive in any setting and often requires formal behavior intervention to manage it.

II. Signs and Symptoms of Acting out Behavior

Behavioral symptoms:

Physical aggressiveness

Verbal aggressiveness

Angry outbursts

Physically attacking people and/or objects

Damaging property

Verbal or physical threats

Pacing, clenching fists

Raising voices, yelling, staring.

Self-destructive behavior

Physical symptoms:

Headaches

Muscle tension

Chest tightness

Palpitations

Tremors

Tightness in chest, feeling hot

Cognitive symptoms:

Low frustration tolerance

Feeling a loss of control over one’s thoughts

Racing thoughts

Hostile, self-talk

Hallucinations

Delusions, paranoid ideations

Confusion.

Psychosocial symptoms:

Feelings of rage

Uncontrollable irritability

Isolation or withdrawal

Excessive talking.

Emotional Symptoms:

Depression

Anxiety

Irritability

Agitation

Fear

jealousy

III. Factors/Events That Trigger Acting-out Behavior

Environment

Traffic congestion

Crowded buses

Being wrong directions

Bad weather

School

Poor academic performance

Conflicts with professors, schoolmates

Parking.

Having an untidy roommate

Relationships with others

A friend joking about a sensitive topic

Being wrongly accused

Having a neighbor who plays the stereo too loud.

Health Care Facilities

Long wait to see Doctors, clinicians or get medications or other services.

Misunderstanding between patients and Doctors, clinicians or administrative staff

Genetic: It has been hypothesized that the traits that this disorder is composed of are passed down from parents to children; however, there is presently not any specific gene identified as having a prominent impact in the development of aggressive behaviors.

The Brain-Behavior Connection: Research suggests that aggressive behavior may occur as the result of abnormalities in the areas of the brain that regulate arousal and inhibition. Frontal lobes are associated with functions such as impulse control, behavioral inhibition, reasoning and decision making. If the frontal lobe is damaged, the result may be aggression may result. Serotonin, which works to send chemical messages throughout the brain, may be composed differently in people with intermittent explosive disorder.

Environmental: The environment in which a person grows up can have a large impact on whether or not he or she develops acting out behaviors. People who grow up in homes where aggression is a common expression of distress or impulsive reactions will follow the example set by their parents and will act out aggressively. In addition, watching violent movies or TV shows also contributes to violent behaviors.

Staff role in Tension Reduction

These Top 10 De-Escalation Tips will help us respond to difficult behavior in the safest, most effective way possible.

TIP 1Be empathic and nonjudgmental
When someone says or does something we perceive as weird or irrational, try not to judge or discount their feelings. Whether or not we think those feelings are justified, they are real to the other person. Pay attention to them.

Keep in mind that whatever the person is going through, it may be the most important thing in their life at the movement.

TIP 2Respect personal space.
If possible, stand 1.5 to 3 feet away from a person who’s escalating. Allowing personal space tends to decrease a person’s anxiety and can help us prevent acting-out behavior.

If we must enter someone’s personal space to provide care, explain our actions so the person feel less confused and frightened.

TIP 3Use non-threatening/non-verbal.
The more a person loses control, the less they hear our words-and the more they react to our nonverbal communication. Be mindful of our gestures, facial expressions, movements, and tone of voice.

Keep our tone and body language neutral will go a long way toward defusing the situation.

TIP 4Avoid overreacting.
Remain calm, rational, and professional. While we can’t control the person’s behavior, how we respond to their behavior will have a direct effect on whether the situation escalates or defuses.

Positive thoughts like “I can handle this” and “I know what to do” will help us maintain our own rationality and calm the person down.

TIP 5Focus on feelings.
Facts are important, but how a person feels is the heart of the matter. Yet some people have trouble identifying how they feel about what’s happening to them. Watch and listen carefully for the person’s real message.

Try saying something like “that must be scary.” Supportive words like these will let the person know that we understand what is happening-and we may get a positive response.

TIP 6Ignore challenging questions.
Answering challenging questions often results in a power struggle. When a person challenges our authority, redirect their attention to the issue at hand.

Ignore the challenge, but not the person. Bring their focus back to how we can work together to solve the problem.

TIP 7Set limits.
If a person’s behavior is belligerent, defensive, or disruptive, give them clear, simple, and enforceable limits. Offer concise and respectful choices and consequences.

A person who’s upset may not be able to focus on everything we say. Be clear, speak simply, and offer the positive choice first.

TIP 8Choose wisely what you insist upon.
It’s important to be thoughtful in deciding which rules are negotiable and which are not. For example, if a person doesn’t want to shower in the morning, can we allow them to choose the time of day that feels best for them?

If we can offer a person options and flexibility, we may be able to avoid unnecessary altercations.

TIP 9Allow silence for reflection.
We have all experienced moments of awkward silence. While it may seem counterintuitive to let moments of silence occur, sometimes it’s the best choice. It can give a person a chance to reflect on what’s happening, and how he or she needs to proceed.

Believe it or not, silence can be a powerful communication tool.

TIP 10Allow time for decisions.
When a person is upset, they may not be able to think clearly. Give them a few minutes to think through what you’ve said.

A person’s stress rises when they feel rushed. Giving them time will allow them to calm down.